Provider First Line Business Practice Location Address:
1624 S I ST
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-5016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-272-8441
Provider Business Practice Location Address Fax Number:
253-272-8096
Provider Enumeration Date:
12/13/2006